Disability Insurance Claim Advice
The Disability Claim Consultant -
Why the Need?
The American Chiropractor, August 2019
By Art Fries
Would you go to court without an attorney? Would you file a tax return without the help of a CPA? Most of you would answer no to these questions.
But, what if you have a disability claim? Are you prepared to go up against the seasoned insurance company claim person who will handle your claim?
Enter the disability claim consultant.
Although few in numbers, they cost no more than other professionals who provide a service that you so readily need and deserve. Their job is to help you secure a monthly benefit and solidify your disability claim for the future. These benefits can involve a substantial amount of money, often running into millions of dollars.
How do you think your disability claim will be handled? What is the reality versus your expectations? Following is a list of the services provided by a disability claim consultant:
Prepare a written audit of your disability policy(s) on forms that have been specially designed for that purpose. They will send you a copy of the audit and discuss the details with you, which will include contractual wording that considers the definition of total disability as well as partial disability. It is very important to know if you can work in another business that is not in conflict with your medical issues and also if earnings from that other business will affect the monthly benefit that is paid. Can you continue your practice or business and hire another chiropractor and still collect the full monthly benefit? Some policies will allow that and others will reduce their benefit as it relates to a total disability definition. The consultant will also discuss pertinent policy wording in other areas that will have an influence on the amount of money paid.
Tell you when to call an insurance company for claim forms. Calling “too early” can jeopardize your rights. When the forms are received you will be provided advice on how to complete the claim forms, which includes not only the claimant’s forms but those that must be completed by the attending physician. You will be advised on who will be the doctor to complete the form and receive advice as to exactly how that form must be completed in order to enjoy a high success rate of approval. Understand that anyone who completes the physician’s form (APS), whether it be your doctor or someone in their office, has never taken a course on how to complete these forms. They do not know the definition of total disability or the difference between the various disability wording as it relates to personal disability policies, group, association, workers’ compensation, state disability or Social Security disability. They must be educated and the disability claim consultant can provide them with that education through you, the direct communicator with the doctor’s office. It is important that forms be completed correctly and with credibility, and just one error by you or your doctor’s office can prevent you from being paid. Does the insurance company want more than one APS completed by all of your doctors? Does your policy(s) say anything on this point? Your consultant can advise you how to respond to this issue.
The consultant will advise you as to what is considered proper medical care and when to seek it.
In addition to the claim forms, the consultant will prepare you for the additional documents that are required that relate to tax returns, procedure codes, and other documents.
When approved or even before, the insurance company will want you to provide “continuation forms” by you and your attending physician with different wording that will also require advice.
The consultant will also provide advice related to video surveillance, a visit by a field representative to your residence as well as advice on how to handle an independent medical evaluation/exam (IME) by a doctor assigned by the insurance company. Sometimes, a functional capacity evaluation (FCE) is allowed by policy language, but often it is not. This is a “test,” usually by a physical therapist, that can take several hours and may determine how much “beating up” parts of your body can take.
There are various questions that you will want to ask related to your disability claim that require accurate answers and often cannot be answered by the agent, broker or association who sold you the policy(s).
Some companies like to offer a “buyout” of the claim after it has been approved. The consultant should be able to provide advice in this area as to what is a fair figure and what isn’t.
What activities can you participate in "post disability"? Do you like to golf, ski or play tennis? Will these be in conflict with your medical issues?
The consultant can also help you prepare additional documents that may not be asked for but help to clarify your claim as it relates to the hours you work and the medical history that prompted you to seek disability benefits.
In essence, a disability claim consultant can reduce your anxiety and pave the road so that you have the highest chance of success as it relates to collecting on a disability claim. It is their job to present you in the best possible "light" so that you do not have to seek legal recourse because you failed to recognize the valuable services provided by a disability claim consultant.
Art Fries is a disability claim consultant providing advice on a national basis in the U.S. He is located in Nipomo, California. He can be reached at 800-567-1911 or firstname.lastname@example.org.